Retrospective Review of Norethindrone Use in Adolescents

Study Objective: Our objectives were to review norethindrone use in an adolescent population in a tertiary care center and to assess the effectiveness of the norethindrone taper in the management of acute heavy menstrual bleeding in adolescents. Design: Retrospective cohort study. Setting: Tertiary care center. Participants: 176 adolescent females prescribed norethindrone 0.35 mg between July 2007 and September 2010. Interventions: None. Main Outcome Measures: Discontinuation and irregular bleeding rates. Results: Mean age was 14.8 +/- 2.3 years. Most common indication for use was heavy menstrual bleeding (32.9%). Most common reasons for use of a progestin only pill were neurologic (27.8%) and cardiovascular diseases (17.6%). Discontinuation rate was 48.5%, most commonly for irregular bleeding (54.5%). Irregular bleeding and systemic side effects were associated with discontinuation (P = .006 and .003 respectively). No serious adverse events were reported. Twenty patients required norethindrone taper for heavy bleeding; of this group 78.9% experienced complete cessation of bleeding within 7 days. Conclusions: Our findings support use of norethindrone as an effective alternative among adolescents with contraindications to administration of estrogen and for whom control of acute heavy menstrual bleeding is desired.